Archive for the ‘Flight Medicine’ Category

Most people think flying doctors only work in Australia. Not true. Every year thousands of travellers rely on flying doctors based in the UK to get them out of dangerous locations abroad or fly them home after they’ve fallen ill.

So it seems strange that so little is written about British flying doctors. Where do they fly to and what kind of emergencies do they deal with? How is it different from the Australian stereotype? Who foots the bill? This series of articles answers these questions and breaks down the stats on 140 consecutive flying doctor missions in and out of the UK over a four year period.

I am a British flying doctor and have been since 2005. Before that I spent 12 years working as a surgeon in the UK National Health Service with a few years in intensive care medicine and various other hospital specialties along the way. Around the time I should have been applying for higher specialist training a friend told me that I could get paid by the hour to fly abroad, pick up medical patients and bring them home on a plane. Curious, I took a job out to Australia to bring a young tetraplegic patient back to the UK who had been stabbed in the neck. It was a difficult and exhausting journey but he and his family were hugely grateful to get back safely and I found the whole thing immensely satisfying. I decided to switch specialties.

Basically, it works like this. The Brits travel abroad more than any nation on earth, roughly half the population every year. Inevitably a percentage of them fall ill while they’re abroad and not all of them get well enough to fly home again on their own. Some need doctors to look after them on board the flight.

Sometimes the patient gets better but still carries a risk of falling ill again on the flight, for example heart attacks, epileptic seizures and collapsed lungs. The airlines don’t want to risk diverting their aircraft because it costs them so much money, so they issue medical clearance provided there’s a doctor on board the jet to deal with any inflight emergencies.

Sometimes the patient needs specialist equipment or treatment such as ventilators, intravenous infusions or constant monitoring. These patients need private jets kitted out like intensive care units – in other words air ambulances.

Or sometimes people are unlucky enough to fall ill in parts of the world that simply don’t have the resources to treat them. For example some countries have blood transfusion stocks contaminated with HIV, or have no intensive care units for very sick patients. This requires evacuation to the nearest regional centre and a flying doctor to give emergency treatment en route.

So there are some similarities to the Australian Flying Doctor service, but most of the action takes place on board international flights. It’s generally paid for through UK travel insurance, but sometimes the NHS covers repatriation of foreign nationals to their home country, and sometimes people without insurance or high net worth individuals pay privately.

This breakdown of the primary medical condition responsible for each of 138 consecutive sorties between 2007 and early 2012 shows the most common reason why UK based flying doctors are needed: heart attack. This is followed by epileptic seizures, collapsed lungs and cardiac arrhythmias. All of these conditions can relapse on board and require prompt treatment by a doctor to avoid diverting the aircraft.

Work tends to be seasonal and follow the leisure travel market. During the summer there is more work in Europe, especially Spain and the Canary Islands. Over the UK winter I travel all over the world, especially Thailand, South Africa and Australia. Passengers falling ill and disembarking from cruise ships take me off the beaten track to destinations such as Borneo and Alaska.

Doctors rarely take patients on planes unless they’re confident it’s safe to do so, although sometimes the circumstances force your hand. Most of my patients are at increased risk but still make it back to the UK without any problems. However inflight medical emergencies do happen and they can be awkward to treat with limited resources and high workload.

It’s statistically more likely for me to find myself dealing with random inflight emergencies on other passengers who just happen to get sick. With those included I deal on average with one inflight emergency for every ten medevacs. This probably explains the wide range of medical emergencies you can see in the pie chart below.

All of these inflight emergencies had happy endings apart from one, which needed emergency surgery on the ground for which a well known British Airline refused to divert. Sadly that young girl ended up with chronic disability.

But I’ve had some fairly spectacular results, including a catastrophic stroke in a 91 year old half an hour out of Heathrow who was sitting up in bed reading the Telegraph four hours later (we blue-lighted him to a stroke centre to inject ‘clot-buster’ into his basilar artery thrombosis) and a 19 year old girl whose blood pressure dropped dangerously low over the Australian outback due to a heart rate of 250 which required a maneuvre to stop her heart for ten seconds to reset it. Thankfully it did start again in a normal rhythm and we avoided diverting an Airbus A380’s worth of passengers.

So in summary, 91% of my patients get to their destination safely, 5% deteriorate or die before I can get to them and 4% have inflight emergencies on the way back (all of whom have survived). I keep in touch with most of my patients after they get home until they’re back to full fitness. I also try to Tweet on medevacs when I’ve got mobile coverage.